Regulatory Affairs Specialist - Medacaid

Overview

Blue Sprig Pediatrics, Inc is committed to advancing the mission of changing the world for children withautism and delivering services to families impacted by Autism Spectrum Disorder. As a leader in the industry and a driver of quality excellence, this position will provide for a systematic approach to regulatory affairs including, monitoring of state Medicaid requirements, coordinating existing and new state entry submissions for Medicaid certification and any associated licensure, drafting advocacy materials, and building key relationships and serving as a liaison with state Medicaid personnel. This position builds strong collaborative relationships to foster industry advocacy and strategically balance regulatory requirements, marketing objectives, compliance, and costs. The role reports to the Senior Vice President of Client Services and collaborates with various levels of operational and clinical leadership and support services.

Job Duties and Responsibilities include the following. Other duties may be assigned.

• Regularly monitors and analyzes Medicaid and government related regulations, including payment, delivery models, cost/value assessment, clinical, and quality measures.
• Strategically balances regulatory requirements, marketing objectives, compliance, and costs associated with Medicaid expansion.
• Advises teams on premarket regulatory requirements, including clinical specifics.
• Collaborates on MCO contracting, network relations, Medicaid reform, and credentialing.
• Works with internal and external resources to determine regulatory and payer requirements for initial certifications, recertifications, changes in locations, and certification and status changes.
• Prepares documents, manages information, maintains electronic files, and coordinates tasks across multiple departments to facilitate timely notice and services under Medicaid.
• Monitors the development of current and emerging Medicaid related issues to identify opportunities to advocate for identified priorities.
• Drafts and prepares advocacy materials such as comment letters, position statements, and talking points to advance the BlueSprig mission and access to services.
• Builds and maintains relationships with key state Medicaid personnel.
• Conducts internal regulatory meetings to discuss Medicaid policy issues and advocacy strategies.
• Represents BlueSprig at external stakeholder Medicaid meetings.
• Presents on behalf of BlueSprig in a variety of public and professional settings.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience

Minimum of a bachelor’s degree; preferred coursework in Political Science, Public Health, Health Policy, and/or Healthcare Administration. BCBA credentials a plus. Combined experience in state, government, and public policy in healthcare preferred. Experience analyzing and crafting responses to healthcare legislation. Experience analyzing and crafting responses to healthcare legislation. Strong interpersonal, presentation, and written and verbal communication skills. Demonstrated organizational and resource management skills; ability to prioritize simultaneous tasks. Experience in ABA and autism industry preferred. 

Certificates and Licenses

Board Certified Behavior Analyst certification in good standing preferred; licenses in current state of practice. May require additional licenses, as needed.

Travel Requirements

Traveling up to 30% as needed within region/territory. Have reliable means of transportation. Meet requirements of our Motor Vehicle policy